Date of Paper/Work


Type of Paper/Work

Doctor of Nursing Practice Project

Degree Name

Doctor of Nursing Practice



First Advisor

Gay Varecka


Doctor of Nursing Practice



Organ transplant centers are under increased scrutiny to reduce costs while improving patient outcomes (Toledo et al., 2013). Length of stay (LOS) is a quality metric that reflects the quality of a transplant center and the utilization of health care dollars (Rana et al., 2017). A large, urban, academic transplant center has persistent, prolonged LOS in their first-time liver transplant (LT) recipients when compared to the national average.


The aim of this quality improvement (QI) project is to determine if initiation of a clinical pathway for adult liver transplant recipients at an urban academic transplant center, accompanied by staff education, will bring LOS closer to the national standard of 8 days.


A Plan-Do-Study-Act design was implemented to effect change quickly, to increase knowledge, and create process improvement. LT patients were followed from transplant until discharge via chart reviews. Variables were monitored looking for patterns that prolong LOS and adherence to the clinical pathway. As barriers were uncovered, they were researched and presented to the transplant team.


A total of 19 LT recipients were admitted between February 18 and April 29, 2022. Seven recipients were excluded, one was a multi-organ transplant, one liver was from a living donor, two were brought back to the operating room for bleeding and abdomens were left open for wash outs, one was found to have an infection in the abdominal cavity when opened for transplant and two others never left the ICU.

The transplant team was educated on the current clinical pathway and hospital metrics. See Figure 3. The clinical pathway was developed using current standards of care for LT recipients. Every three weeks the transplant team was updated on any standards that were not being met according to the clinical pathway.

The transplant team was encouraged to give input on barriers that delayed adherence to the clinical pathway. Common barriers included insomnia, delirium, and decreased activity levels. These three variables were researched, and evidence-based interventions were disseminated to the transplant team using laminated tip sheets posted throughout the unit. At conclusion of this project LOS had trended down from 12 to 11.3 days, there was limited staff engaged (10%), and knowledge of the clinical pathway increased (100%).


The use of a clinical pathway to direct care in first time liver transplant patients paired with transplant team education led to a decreased LOS from 12 days to 11.3 days. Although the data set is small and cannot be analyzed statistically, the information gathered can be used to steer future QI projects at this transplant center.

Available for download on Tuesday, July 23, 2024